Midwives’ perceptions of barriers to exclusive breastfeeding in Bhutan: A qualitative study

Healthcare providers' perceived barriers to providing breastfeeding support in Northwest rural China

BACKGROUND

Healthcare providers play important roles in supporting breastfeeding. Although there has been insufficient actual breastfeeding support from healthcare providers in China, little research has been conducted to understand Chinese healthcare providers' perceived barriers to providing breastfeeding support, especially in rural China. This study aims to identify these perceived barriers to providing breastfeeding support in Northwestern rural China.

METHODS

This study was conducted during the period from March 2018 to December 2018. Forty-one healthcare providers were recruited through purposive sampling in two rural counties in Northwest China that are in close proximity to each other and share similar demographic features. Participants included obstetrician-gynecologists, midwives, nurses, "village doctors", and township and village maternal and child health workers. Qualitative data were collected through one-on-one in-depth semi-structured interviews and focus group discussions. Transcripts were thematically analyzed.

RESULTS

Analysis of interview data resulted in four themes that the participants perceived as barriers to supporting breastfeeding: (1) lack of medical resources, within which inadequate staffing, and lack of financial incentives were discussed, (2) lack of clear and specific responsibility assignment, within which no one takes the lead, and mutual buck-passing were discussed, (3) healthcare providers' lack of relevant expertise, within which lack of knowledge and skills, and low prestige of village healthcare providers were discussed, (4) difficulties in accessing mothers, within which medical equipment shortages reduce services utilization, mothers' housing situation, mothers' mobility, and cultural barriers were discussed.

CONCLUSIONS

The study identified HCPs perceived barriers to providing breastfeeding support. Unique to China's Tri-Level Healthcare System, challenges like staffing and financial incentives are hard to swiftly tackle. Recommendations include mHealth enhancement and clarified responsibilities with incentives and tailored training. Further research is crucial to evaluate these strategies in rural Northwestern China and comparable underdeveloped areas nationwide.

Strengthening midwifery in the South-East Asian region: A scoping review of midwifery-related research

Improving sexual, reproductive, maternal, newborn, and adolescent health outcomes necessitates greater commitment to, and investments in, midwifery. To identify future research priorities to advance and strengthen midwifery, we conducted a scoping review to synthesise and report areas of midwifery that have been explored in the previous 10 years in the 11 countries of the World Health Organization's South-East Asia region. Electronic peer-reviewed databases were searched for primary peer-reviewed research published in any language, published between January 2012 and December 2022 inclusive. A total of 7086 citations were screened against the review inclusion criteria. After screening and full text review, 195 sources were included. There were 94 quantitative (48.2%), 67 qualitative (34.4%) and 31 mixed methods (15.9%) studies. The majority were from Indonesia (n = 93, 47.7%), India (n = 41, 21.0%) and Bangladesh (n = 26, 13.3%). There were no sources identified from the Democratic People's Republic of Korea or the Maldives. We mapped the findings against six priority areas adapted from the 2021 State of the World's Midwifery Report and Regional Strategic Directions for Strengthening Midwifery in the South-East Asia region (2020-2024): practice or service delivery (n = 73, 37.4%), pre-service education (n = 60, 30.8%), in-service education or continuing professional development (n = 51, 26.2%), workforce management (n = 46, 23.6%), governance and regulation (n = 21, 10.8%) and leadership (n = 12, 6.2%). Most were published by authors with affiliations from the country where the research was conducted. The volume of published midwifery research reflects country-specific investment in developing a midwifery workforce, and the transition to midwifery-led care. There was variation between countries in how midwife was defined, education pathways, professional regulation, education accreditation, governance models and scope of practice. Further evaluation of the return on investment in midwifery education, regulation, deployment and retention to support strategic decision-making is recommended. Key elements of leadership requiring further exploration included career pathways, education and development needs and regulatory frameworks to support and embed effective midwifery leadership at all levels of health service governance.

The practice of exclusive breastfeeding by region in Indonesia

OBJECTIVE

Exclusive breastfeeding has important benefits for both children and mothers. However, the proportion of exclusive breastfeeding is still not evenly distributed among regions, including in Indonesia. The purpose of this study was to analyze the practice of exclusive breastfeeding by region in Indonesia and its influencing factors.

STUDY DESIGN

This study was cross-sectional study.

METHODS

This study used secondary data from the Indonesia Demographic and Health Survey 2017. The total sample was 1621 respondents, which consisted of mothers whose last child was under six months old and was still alive; the mothers did not have twins and lived with their child. Data were analyzed by using Quantum GIS and binary logistic regression statistical tests.

RESULTS

This study shows that 51.6% of respondents gave exclusive breastfeeding in Indonesia. The highest proportion was in the Nusa Tenggara region (72.3%), whereas the lowest was in Kalimantan province (37.5%). Mothers who lived in the regions of Nusa Tenggara, Sulawesi, Java-Bali, and Sumatra had a higher chance of exclusive breastfeeding compared to those in the Kalimantan region. The factors associated with the exclusive breastfeeding vary widely across all regions, and the child's age is the only common factor associated with the exclusive breastfeeding in all regions, except Kalimantan.

CONCLUSION

This study shows wide variation in regional proportions and determinants of exclusive breastfeeding in Indonesia. Therefore, appropriate policies and strategies are needed to increase equitable exclusive breastfeeding practices across all regions in Indonesia.

Do maternal grandmothers influence breastfeeding duration and infant nutrition? Evidence from Merida, Mexico

OBJECTIVES

Breast-feeding is sensitive to somatic, hormonal, behavioral and psychological components of maternal capital. However, through grandmothering, older women may also influence breast-feeding by transferring informational resources to their daughters. We hypothesized that mothers with prolonged instrumental support from their own mother are more likely to have received advice and to have favorable attitudes/practices regarding breastfeeding, compared to those lacking such support, with implications for the grandchild's somatic capital.

METHODS

We recruited 90 mother-infant dyads (52 with grandmaternal support, 38 without) in Merida, Yucatan, Mexico. All children were first-borns, aged ~2 years. Anthropometry and body composition were assessed. Data on grandmother's breastfeeding advice and maternal breastfeeding duration were obtained by questionnaire. Maternal attitudes to breast-feeding were assessed using the Iowa Infant Feeding Attitude Scale.

RESULTS

Women with instrumental support were more likely to have received grandmaternal advice during pregnancy/infancy on exclusive breast-feeding duration (60% vs. 37%, p = 0.033) and the type of first complementary food (81% vs. 47%, p = 0.001). However, women with support had a less favorable attitude to breastfeeding than those without and breastfed their children for less time (median 5 vs. 10.5 months, p = 0.01). No group differences were found in children's length, weight, skinfolds or lean mass z-score.

DISCUSSION

Although grandmothers providing instrumental support provided advice regarding breastfeeding, their attitudes may reflect issues beyond nutritional health. Advice of maternal grandmothers did not promote extended breastfeeding, however the differences in breastfeeding attitudes were not associated with the children's nutritional status. Grandmothers should be included in public health interventions promoting breastfeeding.

Breastfeeding and Human Lactation Curriculum Survey of Midwifery Programs in the United States

INTRODUCTION

The health attributes and advantages of breastfeeding are well documented in the literature. Current research identifies the importance of comprehensive lactation knowledge among health care professionals to improve breastfeeding outcomes. Educational curricula to incorporate lactation content is necessary for student preparedness to provide competent care. Midwives are in a unique position to support, promote, and manage breastfeeding. The purpose of this study was to survey Accreditation Commission for Midwifery Education (ACME)-accredited midwifery education programs in the United States for their breastfeeding curricular content including opportunities for clinical experiences in managing and counseling breastfeeding parents.

METHODS

A descriptive survey was deployed online to midwifery programs listed by the American College of Nurse-Midwives, with a response completion rate of 44.7%. Data collection included program descriptors, hours of lactation content, educational topics, faculty preparation, use of simulation, and clinical breastfeeding experiences.

RESULTS

Descriptive analyses revealed differences among the midwifery education programs surveyed regarding the amount of lactation content and clinical opportunities. Two programs offer a course specific to breastfeeding, with the remaining programs providing lactation content threaded throughout their curricula; 29.4% of programs offer 3 to 4 hours of lactation content, 35.3% report 5 to 8 hours of content, and 11.8% provide at least 10 hours of content. One program reports 18+ hours of content provided in both didactic and clinical settings. All programs report providing breastfeeding clinical opportunities for students; 18% of programs offer simulation experiences. No programs report using standardized lactation clinical competencies.

DISCUSSION

Midwives play a pivotal role in breastfeeding promotion, counseling, and clinical support. Standardization of didactic lactation education will assist programs in future curriculum mapping. Given the variability of clinical settings and patient access, creating clinical competencies and providing lactation simulation experiences may offer midwifery students a broader opportunity to gain critical skills in lactation management to best support breastfeeding families.

Influence of Health Literacy on Maintenance of Exclusive Breastfeeding at 6 Months Postpartum: A Multicentre Study

Background: International organizations recommend initiating breastfeeding within the first hour of life and maintaining exclusive breastfeeding for the first 6 months. However, worldwide rates of exclusive breastfeeding for 6-month-old infants is far from meeting the goal proposed by the World Health Organization, which is to reach a minimum of 50% of infants. Education is one of the factors affecting the initiation and continuation of breastfeeding, and incidentally, it is also related to lower health literacy. This study explored the influence of health literacy on maintenance of exclusive breastfeeding at 6 months postpartum. Methods: A longitudinal multicenter study with 343 women were recruited between January 2019 and January 2020. The first questionnaire was held during the puerperium (24−48 h) with mothers practicing exclusive breastfeeding, with whom 6-month postpartum breastfeeding follow-up was performed. Socio-demographic, clinical and obstetric variables were collected. Breastfeeding efficiency was assessed using the LATCH breastfeeding assessment tool. The health literacy level was evaluated by the Newest Vital Sign screening tool. A multivariate logistic regression model was used to detect protective factors for early exclusive breastfeeding cessation. Results: One third of the women continued exclusive breastfeeding at 6 months postpartum. Approximately half the participants had a low or inadequate health literacy level. An adequate health literacy level, a high LATCH breastfeeding assessment tool score (>9 points) and being married were the protective factors against exclusive breastfeeding cessation at 6 months postpartum. Conclusion: Health literacy levels are closely related to maintaining exclusive breastfeeding and act as a protective factor against early cessation. A specific instrument is needed to measure the lack of “literacy in breastfeeding”, in order to verify the relationship between health literacy and maintenance of exclusive breastfeeding.

Finding The Needs of Breastfeeding Mother Accompaniment for Successful Exclusive Breastfeeding Until 6 Months in Semarang City: A Mixed Method

Exclusive breastfeeding for the first 6 months of life is important to prevent nutritional problems. WHO has recommended that all babies should be exclusively breastfed for the first 6 months of life. However, its practice in Indonesia is not optimal yet (38%). The aim of this study to assess the characteristics of breastfeeding accompaniment needed by exclusive breastfeeding mothers for the success of exclusive breastfeeding until 6 months. This study used mixed methods, both a cross-sectional survey of 148 mothers breastfeeding infants aged over six months in five PHCs with low level of exclusive breastfeeding coverage and unstructured interviews were conducted by ten PHC midwives in five PHC areas. Most of breastfeeding mothers were housewives, multipara, secondary education, and only (33,8%) breastfeed exclusively. The characteristics of accompaniment needed included scheduled home visits by companion (73.0%), providing information with direct practice by companion and according to the problems experienced by the mothers (77.8%), and accompaniment conducted 0-6 postpartum (85.8%). The qualitative findings that home visits to postpartum mothers by companion carried out only once or twice during the postpartum period with a focus on infant health. In conclusion, most of breastfeeding mothers still need accompaniment during the breastfeeding exclusive period or until 6 months postpartum.

Intention to Practice Exclusive Breastfeeding and its Associated Factors among Female College Students

BACKGROUND: The breastfeeding intention of female students plays an important role in the formation of breastfeeding behavior in the future. Lack of attention to this, both owned by students and those around them, can reduce breastfeeding practices when they become mothers later. Moreover, the process of forming intentions to manifest into behavior takes a long time. Students are considered as an educated group who are expected to be role models in breastfeeding practices in the community. AIM: This study intended to examine the relationship between knowledge, subjective norms, and perceptions (benefits, barriers, and vulnerabilities) toward exclusive breastfeeding intention on female college students of the Public Health department on Universitas Muhammadiyah Surakarta. METHODS: A college basis cross-sectional study was conducted in March 2021. The samples were 187 female students who were willing to participate in the study. The selection of samples using a proportional random sampling technique. Data were collected online questionnaires through an online survey platform. A multi logistic regression test was deployed to examine the exclusive breastfeeding intention and its associated factors on a 95% confidence interval. RESULTS: Results show that subjective norm is significantly associated with breastfeeding intention (p < 0.05). Students who had supportive subjective norm twice likely to had the intention to practice exclusive breastfeeding OR value 2.22 95% CI (1.07–4.06). CONCLUSION: Overall, the intention to exclusively breastfed their child was related to the student’s subjective norm. The results of this study have an impact on female students to strengthen their intentions and increase their efforts to plan exclusive breastfeeding when they become mothers. Hence, educational communication is needed to the environment around young women regarding the importance of exclusive breastfeeding so that the social environment can provide support to adolescents in the success of exclusive breastfeeding.

Exclusive Breastfeeding Practice in Indonesia: A Population-Based Study

BACKGROUND

It is a well-known fact that exclusive breastfeeding benefits both mothers and their babies. The aim of this study is to assess the associated factors influencing exclusive breastfeeding of babies until 6 months of age.

METHODS

The study used data from the 2017 Indonesia Demographic and Health Survey. Overall, 1,542 women who had infants aged below 6 months were included in the study. Sociodemographic and maternal health service utilization factors were examined for association with exclusive breastfeeding, using logistic regression for a complex sample design.

RESULTS

The proportion of exclusive breastfeeding was 52.3% (95% confidence interval [CI], 0.498-0.548). Parity, antenatal care visits, early initiation of breastfeeding, low-income households, and rural areas were significant factors associated with the increased likelihood of exclusive breastfeeding. However, working status (adjusted odds ratio [aOR], 0.70; 95% CI, 0.57-0.86) and caesarean delivery or C-section (aOR, 0.75; 95% CI, 0.57-0.99) were factors for a lower likelihood of exclusive breastfeeding.

CONCLUSION

Working women are at risk of discontinuation of exclusive breastfeeding. Mothers who had a normal vaginal delivery and practiced early initiation of breastfeeding had a higher rate of exclusive breastfeeding. These findings have important implications for developing comprehensive guidance and resources for women regarding the importance of exclusive breastfeeding during the early postpartum period.

Integrative Review of the Experiences of Registered Nurses Who Support Breastfeeding Women

OBJECTIVE

To describe the experiences of registered nurses (RNs) who support breastfeeding women and to understand the factors that they believe affect practices that support breastfeeding.

DATA SOURCES

We conducted an online search using five databases: Scopus, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Database of Systematic Reviews, and Joanna Briggs Institute of Systematic Reviews.

STUDY SELECTION

We included original research articles on the experiences of RNs who support breastfeeding women that were published in 2009 or after and were available in English. After title and abstract review of 785 articles, we included 22 articles for full text review. Nine articles met the eligibility criteria and were included in the review.

DATA EXTRACTION

We used Whittemore and Knafl's five-step framework and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines to guide this integrative review. Three authors reviewed and appraised the articles independently.

DATA SYNTHESIS

We categorized the findings into three themes: Workplace Issues, Personal Experiences, and Breastfeeding Knowledge and Education. Workplace Issues included the subthemes Lack of Time and Workload and Infant Health Stability. Personal Experiences included the subthemes Attitudes, Individual Experiences With Breastfeeding, and The Experiences of Family and Friends. Breastfeeding Knowledge and Education included the subthemes Prelicensure Education and Workplace Education and Training. Most researchers identified deficits in knowledge and education among RNs. The concept of confidence was influenced by all the other themes. Participants in the included studies reported that they developed confidence after learning from lactation consultants and having role models who supported the development of their knowledge and skills.

CONCLUSION

Despite the heterogeneity among the studies, findings highlighted the need for an increased focus on the preparation of RNs to support women to effectively breastfeed within health care organizations. Multitargeted efforts, such as orientation programs and in-depth breastfeeding education using role modeling, mentorship, and role playing with practical scenarios, may improve RNs' abilities and confidence to support breastfeeding women.